Healthcare Provider Details

I. General information

NPI: 1720005259
Provider Name (Legal Business Name): MIN SOO SHIN MD,APC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2968 E FLORENCE AVE
HUNTINGTON PARK CA
90255
US

IV. Provider business mailing address

2968 E FLORENCE AVE
HUNTINGTON PARK CA
90255
US

V. Phone/Fax

Practice location:
  • Phone: 323-583-1500
  • Fax: 323-583-1661
Mailing address:
  • Phone: 323-583-1500
  • Fax: 323-583-1661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA40822
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: